Reproducibility and Relative Validity of a Food Frequency Questionnaire to Assess Dietary Intake of Adults Living in a Mediterranean Country

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2019 Jun 18

PMID 31206566

Citations 25

Authors

Carla Aoun

Reine Bou Daher

Nada El Osta

Tatiana Papazian

Lydia Rabbaa Khabbaz

Affiliations

Soon will be listed here.

Abstract

Objective: Food frequency questionnaires (FFQs) must be validated among the population of interest due to the specificities in dietary habits, culture and food in each country of the Mediterranean region. The objective of this study was to determine the relative validity and reproducibility of a 157 item semi-quantitative FFQ among Lebanese adult population.

Material And Methods: Dietary intake was assessed through dietary recalls, a FFQ with food items, and traditional recipes from the Mediterranean cuisine. Validity of the FFQ was measured by comparing the intake of calories, macro and micronutrients to the mean values derived from three dietary recalls (DR). Reproducibility of the FFQ was evaluated after repeating the same FFQ among the participant after a four-month period.

Results: 114 healthy adults aged between 18 and 60 years of which 52.6% are men participated in this study. 53 of these adults participated in the reproducibility study. Intra class correlation coefficient (ICC) between the two FFQ measurements ranged from 0.822 for sodium to 0.998 for energy indicating excellent reproducibility. The FFQ showed slightly higher intakes than the dietary recalls for most of the nutrients and foods reaching 2.1% for nutrients (polyunsaturated fatty acids) and 18% for food groups (olive oil). Correlation coefficients ranged between 0.783 (sodium) and 0.996 (carbs) for nutrients and between 0.906 (fish) and 1 (fruits and nuts) for food groups, with a significant p value (p = 0.038 for folate). Cross-classification of nutrients into quartiles showed that more than 81% of the participants were classified in the same quartile. Misclassifications were low for most nutrients with one to three persons misclassified at the extreme quartiles.

Conclusion: The FFQ used in this research contained western and Mediterranean type of dishes and foods. Statistical analysis showed good reproducibility and validity of the tested tool in a heterogeneous sample of adults living in a Mediterranean country. It is a useful tool for future investigations and strategies promoting the comeback of this traditional diet.

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References

Zaragoza-Marti A, Cabanero-Martinez M, Hurtado-Sanchez J, Laguna-Perez A, Ferrer-Cascales R . Evaluation of Mediterranean diet adherence scores: a systematic review. BMJ Open. 2018; 8(2):e019033. PMC: 5855302. DOI: 10.1136/bmjopen-2017-019033. View

Katsouyanni K, Rimm E, Gnardellis C, Trichopoulos D, Polychronopoulos E, Trichopoulou A . Reproducibility and relative validity of an extensive semi-quantitative food frequency questionnaire using dietary records and biochemical markers among Greek schoolteachers. Int J Epidemiol. 1997; 26 Suppl 1:S118-27. DOI: 10.1093/ije/26.suppl_1.s118. View

Ma Y, Olendzki B, Pagoto S, Hurley T, Magner R, Ockene I . Number of 24-hour diet recalls needed to estimate energy intake. Ann Epidemiol. 2009; 19(8):553-9. PMC: 2803049. DOI: 10.1016/j.annepidem.2009.04.010. View

Kyriacou A, Evans J, Economides N, Kyriacou A . Adherence to the Mediterranean diet by the Greek and Cypriot population: a systematic review. Eur J Public Health. 2015; 25(6):1012-8. DOI: 10.1093/eurpub/ckv124. View

Alexandratos N . The Mediterranean diet in a world context. Public Health Nutr. 2006; 9(1A):111-7. DOI: 10.1079/phn2005932. View

Hebert J, Hurley T, Steck S, Miller D, Tabung F, Peterson K . Considering the value of dietary assessment data in informing nutrition-related health policy. Adv Nutr. 2014; 5(4):447-55. PMC: 4085192. DOI: 10.3945/an.114.006189. View

Soderberg L, Lind T, Karlsland Akeson P, Sandstrom A, Hernell O, Ohlund I . A Validation Study of an Interviewer-Administered Short Food Frequency Questionnaire in Assessing Dietary Vitamin D and Calcium Intake in Swedish Children. Nutrients. 2017; 9(7). PMC: 5537797. DOI: 10.3390/nu9070682. View

Issa C, Darmon N, Salameh P, Maillot M, Batal M, Lairon D . A Mediterranean diet pattern with low consumption of liquid sweets and refined cereals is negatively associated with adiposity in adults from rural Lebanon. Int J Obes (Lond). 2010; 35(2):251-8. DOI: 10.1038/ijo.2010.130. View

Kremmyda L, Papadaki A, Hondros G, Kapsokefalou M, Scott J . Differentiating between the effect of rapid dietary acculturation and the effect of living away from home for the first time, on the diets of Greek students studying in Glasgow. Appetite. 2007; 50(2-3):455-63. DOI: 10.1016/j.appet.2007.09.014. View

10.

Archer E, Lavie C, Hill J . The Failure to Measure Dietary Intake Engendered a Fictional Discourse on Diet-Disease Relations. Front Nutr. 2018; 5:105. PMC: 6243202. DOI: 10.3389/fnut.2018.00105. View

11.

Cantin J, Latour E, Ferland-Verry R, Morales Salgado S, Lambert J, Faraj M . Validity and reproducibility of a food frequency questionnaire focused on the Mediterranean diet for the Quebec population. Nutr Metab Cardiovasc Dis. 2016; 26(2):154-61. DOI: 10.1016/j.numecd.2015.11.003. View

12.

Mohammadifard N, Sajjadi F, Maghroun M, Alikhasi H, Nilforoushzadeh F, Sarrafzadegan N . Validation of a simplified food frequency questionnaire for the assessment of dietary habits in Iranian adults: Isfahan Healthy Heart Program, Iran. ARYA Atheroscler. 2015; 11(2):139-46. PMC: 4568199. View

13.

Malekshah A, Kimiagar M, Saadatian-Elahi M, Pourshams A, Nouraie M, Goglani G . Validity and reliability of a new food frequency questionnaire compared to 24 h recalls and biochemical measurements: pilot phase of Golestan cohort study of esophageal cancer. Eur J Clin Nutr. 2006; 60(8):971-7. DOI: 10.1038/sj.ejcn.1602407. View

14.

Bland J, Altman D . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1(8476):307-10. View

15.

Fallaize R, Forster H, Macready A, Walsh M, Mathers J, Brennan L . Online dietary intake estimation: reproducibility and validity of the Food4Me food frequency questionnaire against a 4-day weighed food record. J Med Internet Res. 2014; 16(8):e190. PMC: 4147714. DOI: 10.2196/jmir.3355. View

16.

Henriquez-Sanchez P, Sanchez-Villegas A, Doreste-Alonso J, Ortiz-Andrellucchi A, Pfrimer K, Serra-Majem L . Dietary assessment methods for micronutrient intake: a systematic review on vitamins. Br J Nutr. 2010; 102 Suppl 1:S10-37. DOI: 10.1017/S0007114509993126. View

17.

Hamdan M, Monteagudo C, Lorenzo-Tovar M, Tur J, Olea-Serrano F, Mariscal-Arcas M . Development and validation of a nutritional questionnaire for the Palestine population. Public Health Nutr. 2013; 17(11):2512-8. PMC: 10282279. DOI: 10.1017/S1368980013002711. View

18.

Tsubono Y, Takamori S, Kobayashi M, Takahashi T, Iwase Y, Iitoi Y . A data-based approach for designing a semiquantitative food frequency questionnaire for a population-based prospective study in Japan. J Epidemiol. 1996; 6(1):45-53. DOI: 10.2188/jea.6.45. View

19.

Jackson M, Walker S, Younger N, Bennett F . Use of a food frequency questionnaire to assess diets of Jamaican adults: validation and correlation with biomarkers. Nutr J. 2011; 10:28. PMC: 3094277. DOI: 10.1186/1475-2891-10-28. View

20.

Illner A, Freisling H, Boeing H, Huybrechts I, Crispim S, Slimani N . Review and evaluation of innovative technologies for measuring diet in nutritional epidemiology. Int J Epidemiol. 2012; 41(4):1187-203. DOI: 10.1093/ije/dys105. View